Intraoperative Fractions of Inspiratory Oxygen Are Associated With Recurrence-Free Survival After Elective Cancer Surgery

Background: Choice of the fraction of inspiratory oxygen (FiO2) is controversial. The objective of this analysis was to evaluate whether intraoperative FiO2 was associated with recurrence-free survival after elective cancer surgery.Methods and Analysis: In this single-center, retrospective study, we...

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Autores principales:	Sarah Dehne, Verena Spang, Rosa Klotz, Laura Kummer, Samuel Kilian, Katrin Hoffmann, Martin A. Schneider, Thilo Hackert, Markus W. Büchler, Markus A. Weigand, Jan Larmann
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	supplemental oxygen therapy postoperative complications perioperative management oxygen related effects recurrence-free survival Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/97cdd72fea2f43ecacbd5c4fb6b2ddee
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spelling	oai:doaj.org-article:97cdd72fea2f43ecacbd5c4fb6b2ddee2021-12-01T06:50:58ZIntraoperative Fractions of Inspiratory Oxygen Are Associated With Recurrence-Free Survival After Elective Cancer Surgery2296-858X10.3389/fmed.2021.761786https://doaj.org/article/97cdd72fea2f43ecacbd5c4fb6b2ddee2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.761786/fullhttps://doaj.org/toc/2296-858XBackground: Choice of the fraction of inspiratory oxygen (FiO2) is controversial. The objective of this analysis was to evaluate whether intraoperative FiO2 was associated with recurrence-free survival after elective cancer surgery.Methods and Analysis: In this single-center, retrospective study, we analyzed 1,084 patients undergoing elective resection of pancreatic (n = 652), colorectal (n = 405), or hepatic cancer (n = 27) at Heidelberg University Hospital between 2009 and 2016. Intraoperative mean FiO2 values were calculated. For unstratified analyses, the study cohort was equally divided into a low- and a high-FiO2 group. For cancer-stratified analyses, this division was done within cancer-strata. The primary outcome measure was recurrence-free survival until the last known follow-up. Groups were compared using Kaplan–Meier analysis. A stratified log rank test was used to control for different FiO2 levels and survival times between the cancer strata. Cox-regression analyses were used to control for covariates. Sepsis, reoperations, surgical-site infections, and cardiovascular events during hospital stay and overall survival were secondary outcomes.Results: Median FiO2 was 40.9% (Q1–Q3, 38.3–42.9) in the low vs. 50.4% (Q1–Q3, 47.4–54.7) in the high-FiO2 group. Median follow-up was 3.28 (Q1–Q3, 1.68–4.97) years. Recurrence-free survival was considerable higher in the high-FiO2 group (p < 0.001). This effect was also confirmed when stratified for the different tumor entities (p = 0.007). In colorectal cancer surgery, increased FiO2 was independently associated with increased recurrence-free survival. The hazard for the primary outcome decreased by 3.5% with every 1% increase in FiO2. The effect was not seen in pancreatic cancer surgery and we did not find differences in any of the secondary endpoints.Conclusions: Until definite evidence from large-scale trials is available and in the absence of relevant clinical conditions warranting specific FiO2 values, perioperative care givers should aim for an intraoperative FiO2 of 50% in abdominal cancer surgery as this might benefit oncological outcomes.Sarah DehneVerena SpangRosa KlotzLaura KummerSamuel KilianKatrin HoffmannMartin A. SchneiderThilo HackertMarkus W. BüchlerMarkus A. WeigandJan LarmannFrontiers Media S.A.articlesupplemental oxygen therapypostoperative complicationsperioperative managementoxygen related effectsrecurrence-free survivalMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	supplemental oxygen therapy postoperative complications perioperative management oxygen related effects recurrence-free survival Medicine (General) R5-920
spellingShingle	supplemental oxygen therapy postoperative complications perioperative management oxygen related effects recurrence-free survival Medicine (General) R5-920 Sarah Dehne Verena Spang Rosa Klotz Laura Kummer Samuel Kilian Katrin Hoffmann Martin A. Schneider Thilo Hackert Markus W. Büchler Markus A. Weigand Jan Larmann Intraoperative Fractions of Inspiratory Oxygen Are Associated With Recurrence-Free Survival After Elective Cancer Surgery
description	Background: Choice of the fraction of inspiratory oxygen (FiO2) is controversial. The objective of this analysis was to evaluate whether intraoperative FiO2 was associated with recurrence-free survival after elective cancer surgery.Methods and Analysis: In this single-center, retrospective study, we analyzed 1,084 patients undergoing elective resection of pancreatic (n = 652), colorectal (n = 405), or hepatic cancer (n = 27) at Heidelberg University Hospital between 2009 and 2016. Intraoperative mean FiO2 values were calculated. For unstratified analyses, the study cohort was equally divided into a low- and a high-FiO2 group. For cancer-stratified analyses, this division was done within cancer-strata. The primary outcome measure was recurrence-free survival until the last known follow-up. Groups were compared using Kaplan–Meier analysis. A stratified log rank test was used to control for different FiO2 levels and survival times between the cancer strata. Cox-regression analyses were used to control for covariates. Sepsis, reoperations, surgical-site infections, and cardiovascular events during hospital stay and overall survival were secondary outcomes.Results: Median FiO2 was 40.9% (Q1–Q3, 38.3–42.9) in the low vs. 50.4% (Q1–Q3, 47.4–54.7) in the high-FiO2 group. Median follow-up was 3.28 (Q1–Q3, 1.68–4.97) years. Recurrence-free survival was considerable higher in the high-FiO2 group (p < 0.001). This effect was also confirmed when stratified for the different tumor entities (p = 0.007). In colorectal cancer surgery, increased FiO2 was independently associated with increased recurrence-free survival. The hazard for the primary outcome decreased by 3.5% with every 1% increase in FiO2. The effect was not seen in pancreatic cancer surgery and we did not find differences in any of the secondary endpoints.Conclusions: Until definite evidence from large-scale trials is available and in the absence of relevant clinical conditions warranting specific FiO2 values, perioperative care givers should aim for an intraoperative FiO2 of 50% in abdominal cancer surgery as this might benefit oncological outcomes.
format	article
author	Sarah Dehne Verena Spang Rosa Klotz Laura Kummer Samuel Kilian Katrin Hoffmann Martin A. Schneider Thilo Hackert Markus W. Büchler Markus A. Weigand Jan Larmann
author_facet	Sarah Dehne Verena Spang Rosa Klotz Laura Kummer Samuel Kilian Katrin Hoffmann Martin A. Schneider Thilo Hackert Markus W. Büchler Markus A. Weigand Jan Larmann
author_sort	Sarah Dehne
title	Intraoperative Fractions of Inspiratory Oxygen Are Associated With Recurrence-Free Survival After Elective Cancer Surgery
title_short	Intraoperative Fractions of Inspiratory Oxygen Are Associated With Recurrence-Free Survival After Elective Cancer Surgery
title_full	Intraoperative Fractions of Inspiratory Oxygen Are Associated With Recurrence-Free Survival After Elective Cancer Surgery
title_fullStr	Intraoperative Fractions of Inspiratory Oxygen Are Associated With Recurrence-Free Survival After Elective Cancer Surgery
title_full_unstemmed	Intraoperative Fractions of Inspiratory Oxygen Are Associated With Recurrence-Free Survival After Elective Cancer Surgery
title_sort	intraoperative fractions of inspiratory oxygen are associated with recurrence-free survival after elective cancer surgery
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/97cdd72fea2f43ecacbd5c4fb6b2ddee
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Intraoperative Fractions of Inspiratory Oxygen Are Associated With Recurrence-Free Survival After Elective Cancer Surgery

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